<title>My Page</title>


<form name="myform" action="simple.php" method="POST">


<input type="checkbox" name="option1" value="o1"> Milk

<input type="checkbox" name="option2" value="o2" checked> Butter

<input type="checkbox" name="option3" value="o3"> Cheese

<input type="text" name="name" value="Mickey" size="20">



</form>
